Paul M Guyre and Allan Munck, Department of Physiology, Dartmouth Medical School, Hanover, New Hampshire, USA

Copyright © 1998 Elsevier Ltd. All Rights Reserved.

The adrenal cortex produces two types of steroid hormones that are essential for life: glucocorticoids and mineralocorticoids. The outer zone of the cortex, the zona glomerulosa, produces the powerful min-eralocorticoid aldosterone. The inner zones, the fas-ciculata and reticularis, produce the glucocorticoids and various androgens. Glucocorticoids act on almost all cells in the body, influencing a host of physiological processes including glucose metabolism, immune and inflammatory reactions, blood pressure regulation, and mental functions. They are essential at basal levels for maintenance of many homeostatic systems. Furthermore they are stress hormones, being secreted at higher than basal rates in response to stress and protecting the organism from stress.

Clinically, glucocorticoids are almost unique among hormones in that they are used for the treatment of a multitude of conditions apparently unrelated to hormone deficiency. Among these conditions are rheumatoid arthritis, asthma, allergy, autoimmune diseases, lymphocytic leukemias and lymphomas. Therapeutic doses used in such cases are often large enough to override normal physiological controls and functions of the glucocorticoids, producing unwanted side-effects.

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